| NPI | 1750791471 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: ID M-17816) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: IN 01075639A) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: OR PG168052) | |
| Enumeration Date | 2014-05-02 |
| Last Update Date | 2024-08-08 |